Concourse Sentinel

Medicaid Integrity Analytics

๐Ÿ“ŠOverview๐ŸงฎSpend Reconciliation๐ŸฅProviders๐Ÿ’ŠProcedures๐Ÿ“Rate Benchmarks๐ŸšจWatchlist๐Ÿ”Statistical Outliers๐Ÿ—‚๏ธReports๐Ÿ‘ฅPopulation Healthโš–๏ธCompare๐Ÿ“ˆTrends๐Ÿ—บ๏ธGeography

Cross-Dataset

๐Ÿ•ธ๏ธControl Clusters๐Ÿ Home Healthโ›”Exclusions (LEIE)๐Ÿ“‹Context & Disclaimers
๐Ÿ‡บ๐Ÿ‡ธAll States

Federal Compliance (CT)

๐Ÿ›๏ธOverview๐Ÿ“ŠOIG QSR๐Ÿ”„Monthly Screeningโธ๏ธยง455.23 Suspensionsโ›”OIG Exclusion Refs๐ŸงพRAC Coordination๐ŸŽฏPERM Sample
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

Updated: Oct 19, 2026

How Connecticut compares

Against 6 peers โ€” similar data coverage. Comparing to a named peer set rather than a 51-state average.

41%High coverageFull benchmarks

Spending per member/month

$960

โˆ’13.3% vs peer median

6th highest of 7 similar states

CMS-64 total รท CMS enrollment

Total Medicaid spending

$10,835,314,555

26th highest of 51 states

CMS-64 Total Net, FY2024

Medicaid enrollment

874,182

27th highest of 51 states

Most recent CMS monthly report

Visible in claims

41.1%

+8.6% vs peer median

2nd highest of 7 similar states

Share of program these claims see

Published figures are FY2024 CMS-64 and CMS enrollment. Claims figures cover 2018โ€“2024.

Public-record research has been run on 38 flagged Connecticut providers, including 10 seeded from the state's enforcement record. Fourteen referrals, the most of any state, nearly all convictions for billing Medicaid psychotherapy or counseling never rendered; Connecticut's June 2022 SUD residential benefit explains the largest structural step changes. Methodology

Connecticut Medicaid Provider Spending

CMS T-MSIS data, 2018-2024

Concourse Sentinel connects to large-scale healthcare billing datasets โ€” including CMS T-MSIS claims, provider enrollment (PECOS), and federal exclusion lists โ€” and runs millions of automated statistical analyses to surface billing anomalies and areas warranting further review.

Cross-Dataset Analysis Available

Watchlist

49 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Control Clusters

NPPES Associations

shared officials and addresses, unscored

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$28.0B

Cumulative, Jan 2018 โ€“ Oct 2024 (6.8 years)

โ‰ˆ $4.1B / year

Total Claims

669.6M

Cumulative, Jan 2018 โ€“ Oct 2024 (6.8 years)

โ‰ˆ 98.0M / year

Unique Providers

7.9K

Distinct billing NPIs, Jan 2018 โ€“ Oct 2024

Watchlist

417

49 highest/critical risk

Current (as of latest ETL)

Monthly Spending Trend
Top 10 Providers by Spending
View all providers โ†’
Spending by Category
Top 10 Procedures by Spending
CodeDescriptionTotal PaidClaims
T1015Clinic service$3.5B23.8M
99285Emergency dept visit hi mdm$1.5B4.6M
T1502Medication admin visit$1.3B24.3M
99284Emergency dept visit mod mdm$1.2B6.5M
99214Office o/p est mod 30 min$1.1B19.3M
90837Psytx w pt 60 minutes$883.7M10.4M
99213Office o/p est low 20 min$834.5M25.5M
99283Emergency dept visit low mdm$775.6M5.6M
H0020Alcohol and/or drug services; methadone administration and/or service$763.4M59.2M
G0463Hospital outpt clinic visit$556.8M6.3M
View all procedures โ†’